Sunday, August 2, 2009

AIR TRAVEL IN PREGNANCY

By Robin Elise Weiss, LCCE, About.com

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Pregnancy was once seen as something that sent women to their homes once their bellies began to protrude, hence the term confinement. It was not considered appropriate for a pregnant women to be seen in public.

Nowadays pregnancy rarely changes our schedules, with the exception of complications. Women continue their normal lives usually for the duration of the pregnancy, with minor exceptions (Like knowing where all the bathrooms are!). Travel is no exception.

Travel is becoming more prevalent as families move further and further away. Traveling for holidays or as a last trip to see the family before the baby or as a last romantic vacation, is not unusual. This even includes out of the country travel and often air travel.

Air travel has had it's share of bad stories told and rumors spread, add pregnancy to the mixture and you probably wouldn't believe the number of things that are said about air travel while pregnant.

Most of the studies on pregnancy and air travel have been done on female flight attendants. One study did show that there was a slight increase in first trimester miscarriage, but this was for the flight attendants who worked a greater number of hours.

Other studies were worried about in-flight radiation. This was also shown to have a slight increase in potential problems. However, these problems were more related to the length of time in the air, the route flown, and other flight phenomena.

As you can see from the medical literature, flying is fairly safe while pregnant, even for the flight attendant, with some minor adjustments. Considering that the average passengers don't fly for extended periods, these concerns are not very relevant to the average flier.

There are some precautions that a pregnant traveler should consider:

Talk to your practitioner before flying. If you are more than 36 weeks pregnant, many airlines will not let you fly for fear that you'll deliver on board.
Try to do the majority of your traveling in the second trimester. Not only will you be more comfortable, but in general the risk of miscarriage and preterm labor are lower.
Avoid excessive flying. Although there are no hard and fast numbers. The flight attendants with the higher miscarriage rates flew on average 74 hours per month.
Make comfort arrangements. Try to get seats with more leg room, plan to walk in the aisles, potty breaks, and water...
Avoid travel to countries that would require immunization. Talk to your practitioner for more info on immunizations.

So remember, flying is not contraindicated in an uncomplicated pregnancy, but use your common sense and speak to your practitioner about your travel plans.

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Radiation Exposure: Air Crew Members (From the FAA)

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Robin Elise Weiss, LCCE
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Saturday, August 1, 2009

Eating Right When Pregnant

Baby Beginnings: Better Health Before PregnancyBaby Beginnings: Better Health Before PregnancyBaby Beginnings: Better Health Before Pr

Eating Right When Pregnant

Good nutrition during pregnancy, and enough of it, is very important for your baby to grow and develop. You should consume about 300 more calories per day than you did before you became pregnant.

Although nausea and vomiting during the first few months of pregnancy can make this difficult, try to eat a well balanced diet and take prenatal vitamins. Here are some recommendations to keep you and your baby healthy.

Pregnancy Tools and Tips

Goals for Healthy Eating When Pregnant

Eat a variety of foods to get all the nutrients you need. Recommended daily servings include 6-11 servings of breads and grains, two to four servings of fruit, four or more servings of vegetables, four servings of dairy products, and three servings of protein sources (meat, poultry, fish, eggs or nuts). Use fats and sweets sparingly.
Choose foods high in fiber that are enriched such as whole-grain breads, cereals, pasta, rice, fruits, and vegetables.
Make sure you are getting enough vitamins and minerals in your daily diet while pregnant. You should take a prenatal vitamin supplement to make sure you are consistently getting enough vitamins and minerals every day. Your doctor can recommend an over-the-counter brand or prescribe a prenatal vitamin for you.
Eat and drink at least four servings of dairy products and calcium-rich foods a day to help ensure that you are getting 1000-1300 mg of calcium in your daily diet during pregnancy.
Eat at least three servings of iron-rich foods per day to ensure you are getting 27 mg of iron daily.
Choose at least one good source of vitamin C every day, such as oranges, grapefruits, strawberries, honeydew, papaya, broccoli, cauliflower, Brussel sprouts, green peppers, tomatoes, and mustard greens. Pregnant women need 70 mg of vitamin C a day.
Choose at least one good source of folic acid every day, like dark green leafy vegetables, veal, and legumes (lima beans, black beans, black-eyed peas and chickpeas). Every pregnant woman needs at least 0.4 mg of folic acid per day to help prevent neural tube defects such as spina bifida.
Choose at least one source of vitamin A every other day. Sources of vitamin A include carrots, pumpkins, sweet potatoes, spinach, water squash, turnip greens, beet greens, apricots, and cantaloupe. Know that excessive vitamin A intake (>10,000 IU/day) may be associated with fetal malformations.

Foods to Avoid When Pregnant

Avoid alcohol during pregnancy. Alcohol has been linked to premature delivery, mental retardation, birth defects, and low birth weight babies.
Limit caffeine to no more than 300 mg per day. The caffeine content in various drinks depends on the beans or leaves used and how it was prepared. An 8-ounce cup of coffee has about 150 mg of caffeine on average while black tea has typically about 80 mg. A 12-ounce glass of caffeinated soda contains anywhere from 30-60 mg of caffeine. Remember, chocolate contains caffeine -- the amount of caffeine in a chocolate bar is equal to 1/4 cup of coffee.
The use of saccharin is strongly discouraged during pregnancy because it can cross the placenta and may remain in fetal tissues. But, the use of other non-nutritive or artificial sweeteners approved by the FDA is acceptable during pregnancy. These FDA-approved sweeteners include aspartame (Equal or NutraSweet), acesulfame-K (Sunett), and sucralose (Splenda). These sweeteners are considered safe in moderation so talk with your health care provider about how much non-nutritive sweetener is acceptable during pregnancy.
Decrease the total amount of fat you eat to 30% or less of your total daily calories. For a person eating 2000 calories a day, this would be 65 grams of fat or less per day.
Limit cholesterol intake to 300 mg or less per day.
Do not eat shark, swordfish, king mackerel, or tilefish (also called white snapper), because they contain high levels of mercury.
Avoid soft cheeses such as feta, Brie, Camembert, blue-veined, and Mexican-style cheese. These cheeses are often unpasteurized and may cause Listeria infection. There’s no need to avoid hard cheese, processed cheese, cream cheese, cottage cheese, or yogurt.
Avoid raw fish, especially shellfish like oysters and clams.

What to Eat When Pregnant and Don't Feel Well

During pregnancy you may have morning sickness, diarrhea, or constipation. You may find it hard to keep foods down, or you may feel too sick to even eat at all. Here are some suggestions:

Morning Sickness: Eat crackers, cereal, or pretzels before getting out of bed; eat small, frequent meals throughout the day; avoid fatty, fried, and greasy foods.
Constipation: Eat more fresh fruit and vegetables. Also drink 6 to 8 glasses of water a day.
Diarrhea: Eat more foods that contain pectin and gums (two types of dietary fiber) to help absorb excess water. Examples of these foods are applesauce, bananas, white rice, oatmeal, and refined wheat bread.
Heartburn: Eat small, frequent meals throughout the day; try drinking milk before eating; and limit caffeinated foods and beverages.

Can I Diet While Pregnant?

No. Do not diet or try to lose weight during pregnancy -- both you and your baby need the proper nutrients in order to be healthy. Keep in mind that you will lose some weight the first week your baby is born.

Can I Eat a "Low Carb" Diet When Pregnant?

Low carbohydrate diets, such as Atkins and the South Beach Diet, are very popular. There have been no studies of the effects of a low carbohydrate diet on pregnancy, so its effect on the fetus, if any, are unknown. While you are pregnant, you should eat a balanced diet from all of the food groups.

Can I Maintain My Vegetarian Diet When Pregnant?

Just because you are pregnant doesn't mean you have to diverge from your vegetarian diet. Your baby can receive all the nutrition he or she needs to grow and develop while you follow a vegetarian diet if you make sure you eat a wide variety of healthy foods that provide enough protein and calories for you and your baby.

Depending on the type of vegetarian meal plan you follow, you may need to adjust your eating habits to ensure that you and your baby are receiving adequate nutrition (you should consume about 300 more calories than you did before you became pregnant).

Why Do I Need More Calcium When Pregnant?

Calcium is a nutrient needed in the body to build strong teeth and bones. Calcium also allows blood to clot normally, muscles and nerves to function properly, and the heart to beat normally. Most of the calcium in your body is found inside your bones.

Your growing baby needs a considerable amount of calcium to develop. If you do not consume enough calcium to sustain the needs of your developing baby, your body will take calcium from your bones, decreasing your bone mass and putting you at risk for osteoporosis. Osteoporosis causes dramatic thinning of the bone, resulting in weak, brittle bones that can easily be broken.

Pregnancy is a critical time for a woman to consume more calcium. Even if no problems develop during pregnancy, an inadequate supply of calcium at this time can diminish bone strength and increase your risk for osteoporosis later in life.

The following guidelines will help ensure that you are consuming enough calcium throughout your pregnancy:

The U.S. Recommended Daily Allowance (USRDA) for calcium is 1000 mg per day for pregnant and breastfeeding women over age 18. The USRDA for teenage girls up to age 18 is 1300 mg of calcium per day.
Eating and drinking at least four servings of dairy products and calcium-rich foods a day will help ensure that you are getting the appropriate amount of calcium in your daily diet.
The best sources of calcium are dairy products including milk, cheese, yogurt, cream soups, and pudding. Calcium is also found in foods including green vegetables (broccoli, spinach, and greens), seafood, dried peas, and beans.
Vitamin D will help your body use calcium. Adequate amounts of vitamin D can be obtained through exposure to the sun and in fortified milk, eggs, and fish.

How Can I Get Enough Calcium If I'm Lactose Intolerant?

Lactose intolerance is the inability to digest lactose, the sugar found in milk. If you are lactose intolerant, you may have cramping, gas, or diarrhea when dairy products are consumed.

If you are lactose intolerant, you can still receive the calcium you need. Here are some suggestions:

Try consuming small amounts of milk with meals. Milk may be better tolerated with food.
You may be able to tolerate certain milk products that contain less sugar including cheese, yogurt, and cottage cheese.
Eat non-dairy calcium sources including greens, broccoli, sardines, and tofu.
Use Lactaid Milk fortified with calcium. Talk to your dietitian about other lactose-reduced products.

Should I Take a Calcium Supplement During Pregnancy?

If you have trouble consuming enough calcium-rich foods in your daily meal plan, talk to your doctor or dietitian about taking a calcium supplement. The amount of calcium you will need from a supplement depends on how much calcium you are consuming through food sources.

Calcium supplements and some antacids containing calcium, such as Tums, may complement an already healthy diet. Many multiple vitamin supplements contain little or no calcium; therefore, you will need an additional calcium supplement.

Why Do I Need More Iron During Pregnancy?

Iron is a mineral that makes up an important part of hemoglobin, the substance in blood that carries oxygen throughout the body. Iron also carries oxygen in muscles, helping them function properly. Iron helps increase your resistance to stress and disease.

The body absorbs iron more efficiently during pregnancy; therefore it is important to consume more iron while you are pregnant to ensure that you and your baby are getting enough oxygen. Iron will also help you avoid symptoms of tiredness, weakness, irritability, and depression.

Following a balanced diet and including foods high in iron can help ensure that you are consuming enough iron throughout your pregnancy. In addition, the following guidelines will help:

The U.S. RDA for iron is 27 mg per day for pregnant women and 15 mg for breastfeeding women.
Eating at least three servings of iron-rich foods a day will help ensure that you are getting 30 mg of iron in your daily diet. One of the best ways to get iron from your diet is to consume a highly fortified breakfast cereal such as Total, which has 18 mg of iron. Note that iron intake is not equal to iron absorption. Absorption of iron into the body is greatest with meat sources of iron such as liver.
The best sources of iron include enriched grain products, lean meat, poultry, fish, and leafy green vegetables.

What Are Good Sources of Iron?

Meat and Seafood: Lean beef, chicken, clams, crab, egg yolk, fish, lamb, liver, oysters, pork, sardines, shrimp, turkey, and veal.
Vegetables: Black-eyed peas, broccoli, Brussel sprouts, collard and turnip greens, lima beans, sweet potatoes, and spinach.
Legumes: Dry beans and peas, lentils, and soybeans.
Fruits: All berries, apricots, dried fruits, including prunes, raisins and apricots, grapes, grapefruit, oranges, plums, prune juice, and watermelon.
Breads and Cereals: Enriched rice and pasta, soft pretzel, and whole grain and enriched or fortified breads and cereals.
Other Foods: Molasses, peanuts, pine nuts, pumpkin, or squash seeds.

Should I Take an Iron Supplement During Pregnancy?

Talk to your health care provider about an iron supplement. The National Academy of Sciences recommends that all pregnant women following a balanced diet take an iron supplement providing 27 mg of iron during the second and third trimesters of pregnancy (that's the amount in most prenatal vitamins). Your doctor may increase this dose if you become anemic. Iron deficiency anemia is a condition in which the size and number of red blood cells are reduced. This condition may result from inadequate intake of iron or from blood loss.

Other Facts About Iron

Vitamin C helps your body use iron. It is important to include sources of vitamin C along with foods containing iron and iron supplements.
Caffeine can inhibit the absorption of iron. Try to consume iron supplements and foods high in iron at least one to three hours before or after drinking or eating foods containing caffeine.
Iron is lost in cooking some foods. To retain iron, cook foods in a minimal amount of water and for the shortest possible time. Also, cooking in cast iron pots can add iron to foods.
Constipation is a common side effect of taking iron supplements. To help relieve constipation, slowly increase the fiber in your diet by including whole grain breads, cereals, fruits, and vegetables. Drinking at least eight cups of fluids daily and increasing moderate exercise (as recommended by your doctor) can also help you avoid constipation.

Food Cravings During Pregnancy

Food cravings during pregnancy are normal. Although there is no widely accepted explanation for food cravings, almost two-thirds of all pregnant women have them. If you develop a sudden urge for a certain food, go ahead and indulge your craving if it provides energy or an essential nutrient. But, if your craving persists and prevents you from getting other essential nutrients in your diet, try to create more of a balance in your daily diet during pregnancy.

During pregnancy, your taste for certain foods may change. You may suddenly dislike foods you were fond of before you became pregnant. In addition, during pregnancy, some women feel strong urges to eat non-food items such as ice, laundry starch, dirt, clay, chalk, ashes, or paint chips. This is called pica, and it may be associated with an iron deficiency such as anemia. Do not give in to these non-food cravings -- they can be harmful to both you and your baby. Tell your health care provider if you have these non-food cravings.

If you have any problems that prevent you from eating balanced meals and gaining weight properly, ask you health care provider for advice. Registered dietitians -- the nutrition experts -- are available to help you maintain good nutrition throughout your pregnancy.

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Reviewed by Brunilda Nazario, MD on March 16, 2009

Herbal 'remedy' may be hazardous during pregnancy

Ross Tomlin713-798-7973htomlin@bcm.tmc.edu

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Herbal 'remedy' may be hazardous during pregnancy

HOUSTON -- (May 25, 2005) -- A Baylor College of Medicine professor takes issue with a 2004 recommendation by the American College of Obstetrics and Gynecology that the herbal extract ginger is an option for relief of nausea and vomiting associated with pregnancy. In its Practice Bulletin, the College stated that limited evidence supports the use of ginger as a "non-pharmacologic option" for treatment of morning sickness.

Dr. Donald Marcus, a professor of medicine and immunology at BCM, is concerned that the evidence for the safety of such a recommendation is poor. Marcus' opinion piece on the ginger recommendation, co-authored by Dr. Wayne R. Snodgrass of the departments of pediatrics and pharmacology-toxicology at The University of Texas Medical Branch in Galveston, appears in the May 2005 issue of Obstetrics and Gynecology.

Marcus and Snodgrass take issue with the designation of ginger as "non-pharmacologic." Ginger extract contains many chemical compounds, including some that are similar to anti-inflammatory medications that may interfere with blood coagulation or kidney function.

Moreover, there are no rigorous studies of the potential dangers of ginger or other dietary supplements during pregnancy. Marcus cites prior recommendations made by the Teratology Society to the U.S. Food and Drug Administration that dietary supplements cannot be assumed to be safe for an embryo or fetus.

"Although the public and some health care professionals believe that herbal medicines are relatively safe, there are remarkably little data to support that assumption," Marcus's commentary states.

Since the passage of the Dietary Supplement Health and Education Act in 1994, herbal medicines have been classified as dietary supplements. Safety testing is not required and manufacturers of herbal supplements are not required to report findings of adverse side effects to the FDA.

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Last modified: May 7, 2009

Best care for babies comes from healthy moms

BAYLOR COLLEGE OF MEDICINE

Best care for babies comes from healthy moms

By Glenna Picton

Lots of new mothers worry about the care they're providing their babies but the best thing they can do for their newborns is to take care of themselves, said a Baylor College of Medicine obstetrician-gynecologist.

This includes a healthy dose of sleep, diet and exercise, said Todd Ivey, M.D., assistant professor of obstetrics and gynecology at BCM.

"Having a new baby is an adjustment in a woman's life and can often be overwhelming," said Ivey. "A lot of women do not pay attention to themselves. They try to be 'super mom' and feel they have to be everything for everyone. The best way for a new mother to take care of her baby is to take care of herself."

There are lifestyle habits that women can keep up with to minimize new-mom fatigue, said Ivey, also a physician at theBaylor Clinic.

Sleep

"When a new mother is feeling a little down or overwhelmed, we recommend that she get two consecutive, eight-plus hour nights of sleep," said Ivey. "It makes them feel better emotionally and physically."

He also recommends that they sleep when their babies sleep. Ivey understands that getting sleep isn't always that easy, though.

"If the mom finds this difficult, this is the time to enlist help from the spouse or partner, family and friends and schedule some time to sleep."

Nutrition

New mothers should avoid turning to sugars and caffeine to keep their energy high, said Ivey. "It can make that 'crash and burn' affect much worse," he said. Instead, he advises making fruits, vegetables and lean meats a part of the diet.

"A well-balanced diet with proteins and iron-containing foods can help keep mom energized," said Ivey.

Drink plenty of water and avoid alcohol in the six-week period following delivery, especially if you are breastfeeding, he said. Staying on prenatal vitamins is also key to replenishing nutrients for new moms.

Breastfeeding

Breastfeeding may contribute to increased fatigue and poses more physical demands on the new mom, Ivey said. But breast milk is the best source of nutrition for a newborn baby.

"New moms can pump and store the milk to help reduce the strenuous effects of breastfeeding," he said. "We encourage moms to pump, even betweens feedings, to help increase their milk supply."

Having stored breast milk available when mom is resting is a good idea, Ivey said, so that mom's much-needed scheduled sleep is not interrupted when baby needs to be fed.

Exercise

Postpartum changes to a woman's body are not completely reversed until six weeks after delivery, Ivey said, increasing the risk of injury.

"We usually do not recommend new mothers do high-impact activity during this period," said Ivey. "We advise them to start with walking and slowly increase activity."

Ivey suggested simpler exercises like leg slides, head lifts and curls and swimming to boost energy and get back in shape.

"It's important to get clearance from your doctor before starting these exercises, especially if you have had a caesarean section or complicated delivery.

"If you are following these recommendations and the fatigue and low energy continue, then be sure to see your health care provider," said Ivey. "There may be a physical cause such as postpartum depression or thyroiditis, which can both be treated."